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Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder defined by pervasive symptoms of inattention, hyperactivity, and impulsivity. Furthermore, children with ADHD show marked deficits in executive functioning (EF) such as attention, effortful control, and behavior, and are more likely to have poor self-regulatory skills. Current evidence-based interventions for children with ADHD include behavioral treatment (BT), psychopharmacological treatment, and their combination. Many other interventions are often used conjunction with or in lieu of evidence-based treatments for ADHD. One such example is the use of mindfulness-based interventions which have been shown to improve attention, reduce maladaptive behaviors, and increase self-regulatory abilities among children in general education settings. The current study is the first to evaluate the effect of mindfulness intervention in combination with BT on behavior, task-based executive functioning (EF), and mindful awareness in elementary-aged children with ADHD (N = 58). The study took place in a controlled analogue summer program setting (STP) in which children were randomized to receive either the mindfulness intervention in conjunction with BT or to a BT active control condition. Children completed a variety of EF cognitive tasks at baseline and post-treatment. Child behavioral responses were measured as teacher and staff-recorded frequencies of observed behavior. In addition, parent-reported and child self-reported measures on mindful awareness were collected. Overall, there were no beneficial incremental effects of mindfulness when used in combination with intensive BT with regard to observed child behavior, attention and inhibitory control, or mindful awareness. [ABSTRACT FROM AUTHOR]

Summary The nucleus is a critical subcellular compartment for the pathogenesis of polyglutamine disorders, including Huntington’s disease (HD). Recent studies suggest the first 17-amino-acid domain (N17) of mutant huntingtin (mHTT) mediates its nuclear exclusion in cultured cells. Here, we test whether N17 could be a molecular determinant of nuclear mHTT pathogenesis in vivo. BAC transgenic mice expressing mHTT lacking the N17 domain (BACHD-ΔN17) show dramatically accelerated mHTT pathology exclusively in the nucleus, which is associated with HD-like transcriptionopathy. Interestingly, BACHD-ΔN17 mice manifest more overt disease-like phenotypes than the original BACHD mice, including body weight loss, movement deficits, robust striatal neuron loss, and neuroinflammation. Mechanistically, N17 is necessary for nuclear exclusion of small mHTT fragments that are part of nuclear pathology in HD. Together, our study suggests that N17 modifies nuclear pathogenesis and disease severity in HD mice by regulating subcellular localization of known nuclear pathogenic mHTT species. [ABSTRACT FROM AUTHOR]

The conceptual overlap between mind-wandering and attention-deficit/hyperactivity disorder (ADHD)-related impairments is considerable, yet little experimental research examining this overlap among children is available. The current study aims to experimentally manipulate mind-wandering among children with and without ADHD and examine effects on task performance. Participants were 59 children with ADHD and 55 age-matched controls. Participants completed a novel mind-wandering sustained attention to response task (SART) that included non-self-referential and self-referential stimuli to experimentally increase self-referential mind-wandering, reflected by increases in reaction time variability (RTV) following self-referential stimuli. The ADHD group participated in a classroom study with analogue conditions aimed at encouraging self-referential future-oriented thinking (free play/movie before and after class work) compared to a control condition (newscast) and a cross-over methylphenidate trial. The significant interaction between ADHD status and self-referential stimuli on SART performance indicated that self-referential stimuli led to greater RTV among children with ADHD (within-subject d = 1.29) but not among controls. Methylphenidate significantly reduced RTV among youth with ADHD across self-referential (d = 1.07) and non-self-referential conditions (d = 0.72). In the ADHD classroom study, the significant interaction between mind-wandering condition and methylphenidate indicated that methylphenidate led to higher work completion (ds > 5.00), and the free-play mind-wandering condition had more consistent detrimental effects on productivity (ds ≥ 1.25) than the movie mind-wandering condition. This study is the first to manipulate mind-wandering and assess effects among children with ADHD using a behavioral task. Results provide evidence that children with ADHD are uniquely susceptible to mind-wandering interference. [ABSTRACT FROM AUTHOR]

Objective: Evaluate whether stimulant medication improves acquisition of academic material in children with attention deficit hyperactivity disorder (ADHD) receiving small-group, content-area instruction in a classroom setting. Method: Participants were 173 children between the ages of 7 and 12 years old (77% male, 86% Hispanic) who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for ADHD and were participating in a therapeutic summer camp. The design was a triple-masked, within-subject, AB/BA crossover trial. Children completed two consecutive phases of daily, 25-min instruction in both (a) subject-area content (science, social studies) and (b) vocabulary. Each phase was a standard instructional unit lasting for 3 weeks. Teachers and aides taught the material to small groups in a summer classroom setting. Each child was randomized to be medicated with daily osmotic-release oral system methylphenidate (OROS-MPH) during either the first or second of the instructional phases, receiving placebo during the other. Results: Medication had large, salutary, statistically significant effects on children's academic seatwork productivity and classroom behavior on every single day of the instructional period. However, there was no detectable effect of medication on learning the material taught during instruction: Children learned the same amount of subject-area and vocabulary content whether they were taking OROS-MPH or placebo during the instructional period. Conclusions: Acute effects of OROS-MPH on daily academic seatwork productivity and classroom behavior did not translate into improved learning of new academic material taught via small-group, evidence-based instruction. What is the public health significance of this article?: In this controlled study, there was no detectable impact of extended-release methylphenidate on the learning of units of academic material taught via small-group, evidence-based instruction. Methylphenidate improved seatwork productivity and classroom behavior, as in many previous studies, but these benefits did not translate into improved learning of academic material. [ABSTRACT FROM AUTHOR]

This paper describes a limited exposure for posterior C1-C2 arthrodesis aided by percutaneous transarticular fixation. The purpose of this study was to report the fusion rate using the aforementioned method. Fifty-seven patients (54 females and three males) with C1-C2 instability due to rheumatoid disease constituted the material of this study. The exposure was restricted to C0-C3 levels. The drilling and insertion of the screws was done through two mini stab wounds. A special sleeve and screwdriver were developed to facilitate this step. An autogenous iliac bone graft was fixed between the decorticated posterior arch of the atlas and the lamina of the axis vertebra. The mean of the atlantodental interval decreased from 8.5 mm (SD 2.3 mm) to 2.6 mm (SD 0.6 mm) at the immediate postoperative periods and reached 2.7 mm (SD 0.7 mm) after a mean follow-up of 30.4 months (SD 5.6 months). Malposition of the screws was observed in two patients and warranted a second operation in one. Fusion was evident in 98% of the cases. Percutaneous insertion of the screws in posterior C1-C2 transarticular fixation reduces the size of the exposure and the surgical trauma to the cervical segments below the fixation. [ABSTRACT FROM AUTHOR]

Variability in working memory (WM) task selection likely contributes to heterogeneity in effect size estimates of deficiencies in youth with attention-deficit/hyperactivity disorder (ADHD). This has resulted in the development of brief, easy to administer assessments such as the NIH List Sorting Working Memory (LSWM) task from the NIH Cognitive Toolbox in hopes of standardizing measurement of this construct. Unfortunately, substantial questions persist regarding the specific constructs being evaluated by this task (e.g., visuospatial [VS] or phonological [PH] WM) as well as the ability of this task to detect WM deficits in previously identified impaired groups (e.g., ADHD). The current study examines the extent to which the LSWM task is associated with VS and PHWM performance as well as symptoms of ADHD. Additionally, we examined the magnitude of differences between ADHD and Typically Developing (TD) youth on this task relative to empirically derived WM tasks utilized in the past. Forty-six children (25 ADHD, 21 TD) completed multiple WM tasks. The LSWM task was moderately associated with PHWM and demonstrated relatively weaker associations with VSWM. Symptoms of inattention and hyperactivity/impulsivity were unrelated to the LSWM task; whereas tasks assessing PH and VSWM were moderately associated with inattention and weakly associated with hyperactivity (VSWM only). No significant between-group differences in performance emerged on the LSWM task; however, significant large-magnitude group differences were observed on both the PH and VSWM tasks. These findings suggest that the LSWM task may lack the ability to detect WM difficulties in youth with ADHD. [ABSTRACT FROM AUTHOR]

Children with disruptive behavior disorders (DBD) and callous-unemotional traits (CU; i.e., lack of guilt, uncaring) are at risk for a variety of negative trajectories (Frick & White, 2008), and frequently exhibit poorer response-to-treatment than children without CU traits (Haas et al., 2010; Hawes & Dadds, 2005). The current single-case design study describes the process of developing individualized modifications of a Daily Report Card intervention for a nine-year, eleven-month-old boy receiving treatment for disruptive behavior and CU traits in the context of a highly controlled, well-staffed Summer Treatment Program setting. After the child showed an initial non-response to the standard components of the behavior modification program, several treatment adaptations were attempted to maximize treatment response. During the 8-week program, one strategy emerged as superior in which the child was not told which target behaviors were being evaluated until immediately before the reward was given ("mystery" Daily Report Card targets). Results are discussed in the context of ways in which treatment can be maximized for children with both DBD and co-occurring CU traits. Our findings suggest that clinicians who are working with children who initially demonstrate an insufficient response to treatment should consider using iterative, data-driven treatment planning and progress monitoring strategies. [ABSTRACT FROM AUTHOR]

Current evidence-based, school-based interventions for children with attention deficit hyperactivity disorder (ADHD) include academic intervention, behavioral classroom management, and psychopharmacological intervention. However, some approaches that are commonly used have not been studied in controlled evaluations. The current study is the first rigorous evaluation of the effect of occupational therapy (OT) weighted vests and stability balls on classroom behavior and academic productivity in elementary-age children with ADHD (N = 64). The effect of psychostimulant medication and its combination with each of the OT interventions on classroom outcomes was also examined. The study consisted of a 2 (medication: methylphenidate, placebo) × 3 (OT intervention: stability ball, weighted vest, control) within-subjects design and was conducted over a 6-week period in a weekday, 60-min summer classroom. OT intervention was randomized daily within a medication crossover design. Overall, results indicated that medication but not weighted vest nor stability ball interventions resulted in improvement in two key areas of functioning in school settings: following classroom rules and academic productivity. [ABSTRACT FROM AUTHOR]

The current study examined the relative efficacy of behavioral sports training, medication, and their combination in improving sports competence among youth with attention deficit/hyperactivity disorder (ADHD). Participants were 73 youth (74% male; 81% Hispanic) between the ages of 5 and 12 diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed.) ADHD enrolled in a Summer Treatment Program (STP). The study consisted of a 2 (medication: methylphenidate, placebo) × 2 (sports training: instruction and practice, recreational play) between-groups design and was conducted over a 3-week period during the STP. Sports training was conducted with a novel sport, badminton, to limit previous sport knowledge and to differentiate it from concurrent sports training that occurred within the STP. Objective and subjective measures of sports skills, knowledge, and behavior were collected. Results indicated that, relative to recreational play, brief sports training improved observed and counselor-rated measures of sports competence including sports skills, knowledge, game awareness, effort, frustration, and enjoyment. During sports training, medication incrementally improved children's observed rule following behavior and counselor-rated sportsmanship relative to placebo. In the absence of sports training, medication improved behavior, effort, and sport knowledge. Training in sports skills and rules produced the largest magnitude effects on sports-related outcomes. Therefore, skills training, rather than medication alone, should be used in conjunction with behavioral intervention to teach sports to youth with ADHD. It is recommended that medication be used only as an adjunct to highly structured sports skills training for youth who display high rates of negative behavior during sports activities. [ABSTRACT FROM AUTHOR]

Objective: Evidence indicates that children with Attention Deficit Hyperactivity Disorder (ADHD) experience acute and prolonged academic impairment and underachievement including marked difficulty with completing homework. This study is the first to examine the effects of behavioral, psychostimulant, and combined treatments on homework problems, which have been shown to predict academic performance longitudinally. Method: Children with ADHD (ages 5-12, N = 75, 71% male, 83% Hispanic/Latino) and their families were randomly assigned to either behavioral treatment (homework-focused parent training and a daily report card; BPT + DRC) or a waitlist control group. Children also participated in a concurrent psychostimulant crossover trial conducted in a summer treatment program. Children's objective homework completion and accuracy were measured as well as parent-reported child homework behaviors and parenting skills. Results: BPT + DRC had large effects on objective measures of homework completion and accuracy (Cohen's ds from 1.40 to 2.21, ps < .001). Other findings, including unimodal medication and incremental combined treatment benefits, were not significant. Conclusions: Behavioral treatment focused on homework problems results in clear benefits for children's homework completion and accuracy (the difference between passing and failing, on average), whereas long-acting stimulant medication resulted in limited and largely nonsignificant acute effects on homework performance. [ABSTRACT FROM AUTHOR]

Behavioral and pharmacological treatments for children with attention deficit/hyperactivity disorder (ADHD) were evaluated to address whether endpoint outcomes are better depending on which treatment is initiated first and, in case of insufficient response to initial treatment, whether increasing dose of initial treatment or adding the other treatment modality is superior. Children with ADHD (ages 5–12,N= 146, 76% male) were treated for 1 school year. Children were randomized to initiate treatment with low doses of either (a) behavioral parent training (8 group sessions) and brief teacher consultation to establish a Daily Report Card or (b) extended-release methylphenidate (equivalent to .15 mg/kg/dose bid). After 8 weeks or at later monthly intervals as necessary, insufficient responders were rerandomized to secondary interventions that either increased the dose/intensity of the initial treatment or added the other treatment modality, with adaptive adjustments monthly as needed to these secondary treatments. The group beginning with behavioral treatment displayed significantly lower rates of observed classroom rule violations (the primary outcome) at study endpoint and tended to have fewer out-of-class disciplinary events. Further, adding medication secondary to initial behavior modification resulted in better outcomes on the primary outcomes and parent/teacher ratings of oppositional behavior than adding behavior modification to initial medication. Normalization rates on teacher and parent ratings were generally high. Parents who began treatment with behavioral parent training had substantially better attendance than those assigned to receive training following medication. Beginning treatment with behavioral intervention produced better outcomes overall than beginning treatment with medication. [ABSTRACT FROM PUBLISHER]

We conducted a cost analysis of the behavioral, pharmacological, and combined interventions employed in a sequential, multiple assignment, randomized, and adaptive trial investigating the sequencing and enhancement of treatment for children with attention deficit hyperactivity disorder (ADHD; Pelham et al., 201X;N = 146, 76% male, 80% Caucasian). The quantity of resources expended on each child’s treatment was determined from records that listed the type, date, location, persons present, and duration of all services provided. The inputs considered were the amount of physician time, clinician time, paraprofessional time, teacher time, parent time, medication, and gasoline. Quantities of these inputs were converted into costs in 2013 USD using national wage estimates from the Bureau of Labor Statistics, the prices of 30-day supplies of prescription drugs from the national Express Scripts service, and mean fuel prices from the Energy Information Administration. Beginning treatment with a low-dose/intensity regimen of behavior modification (large-group parent training) was less costly for a school year of treatment ($961) than beginning treatment with a low dose of stimulant medication ($1,669), regardless of whether the initial treatment was intensified with a higher “dose” or if the other modality was added. Outcome data from the parent study (Pelham et al., 201X) found equivalent or superior outcomes for treatments beginning with low-intensity behavior modification compared to intervention beginning with medication. Combined with the present analyses, these findings suggest that initiating treatment with behavior modification rather than medication is the more cost-effective option for children with ADHD. [ABSTRACT FROM PUBLISHER]

Fluorogenic probes, due to their often greater spatial and temporal sensitivity in comparison to permanently fluorescent small molecules, represent powerful tools to study protein localization and function in the context of living systems. Herein, we report fluorogenic probe 4, a 1,3,4-oxadiazole designed to bind selectively to transthyretin (TTR). Probe 4 comprises a fluorosulfate group not previously used in an environment-sensitive fluorophore. The fluorosulfate functional group does not react covalently with TTR on the time scale required for cellular imaging, but does red shift the emission maximum of probe 4 in comparison to its nonfluorosulfated analogue. We demonstrate that probe 4 is dark in aqueous buffers, whereas the TTR-4 complex exhibits a fluorescence emission maximum at 481 nm. The addition of probe 4 to living HEK293T cells allows efficient binding to and imaging of exogenous TTR within intracellular organelles, including the mitochondria and the endoplasmic reticulum. Furthermore, live Caenorhabditis elegans expressing human TTR transgenically and treated with probe 4 display TTR- 4 fluorescence in macrophage-like coelomocytes. An analogue of fluorosulfate probe 4 does react selectively with TTR without labeling the remainder of the cellular proteome. Studies on this analogue suggest that certain aryl fluorosulfates, due to their cell and organelle permeability and activatable reactivity, could be considered for the development of protein-selective covalent probes. [ABSTRACT FROM AUTHOR]

Introduction: Although pedicle screw fixation is a well-established technique for the lumbar spine, screw placement in the thoracic spine is more challenging because of the smaller pedicle size and more complex 3D anatomy. The intraoperative use of image guidance devices may allow surgeons a safer, more accurate method for placing thoracic pedicle screws while limiting radiation exposure. This generic 3D imaging technique is a new generation intraoperative CT imaging system designed without compromise to address the needs of a modern OR. Aim: The aim of our study was to check the accuracy of this generic 3D navigated pedicle screw implants in comparison to free hand technique described by Roy-Camille at the thoracic spine using CT scans. Material and methods: The material of this study was divided into two groups: free hand group (group I) (18 patients; 108 screws) and 3D group (27 patients; 100 screws). The patients were operated upon from January 2009 to March 2010. Screw implantation was performed during internal fixation for fractures, tumors, and spondylodiscitis of the thoracic spine as well as for degenerative lumbar scoliosis. Results: The accuracy rate in our work was 89.8 % in the free hand group compared to 98 % in the generic 3D navigated group. Conclusion: In conclusion, 3D navigation-assisted pedicle screw placement is superior to free hand technique in the thoracic spine. [ABSTRACT FROM AUTHOR]

Children with attention deficit hyperactivity disorder (ADHD) make up a considerable proportion of students who receive special education services in schools. The present study aimed to enhance the outcomes of students with ADHD in special education settings by using a daily report card (DRC). Thirty-three children with ADHD in special education placements were randomly assigned to an intervention condition wherein behavioral consultants worked with the teacher and parent to construct and implement a DRC based on the child's individualized education plan goals and objectives. These children were compared to 30 children in a business as usual control condition. Results indicated positive effects of the DRC on observations of classroom functioning, individualized education plan goal attainment, and teacher ratings of academic productivity and disruptive behavior in the classroom. Further, a greater percentage of children with ADHD in the DRC group were normalized on measures of disruptive behavior and impairment. The intervention did not result in incremental improvement in academic achievement, teacher ratings of ADHD symptoms or impairment, or the student-teacher relationship. The implications of these results for working with children with ADHD in special education settings are discussed. [ABSTRACT FROM AUTHOR]

Abstract: We reported the results of the 3-week summer treatment program (STP) for children with attention deficit hyperactivity disorder (ADHD) in 2006. The STP was based on methods established by Professor Pelham in Buffalo, NY and has been used in a number of studies and at a number of sites in the U.S. This is the first STP outside North America. Thirty-six children age 6–12 years with ADHD participated. The collection of evidence-based behavioral modification techniques that comprises the STP’s behavioral program (e.g., point system, daily report card, positive reinforcement, time out) was used. Most children showed positive behavioral changes in multiple domains of functioning, demonstrated by significant improvement in points earned daily, which reflect behavior frequencies. Only one child with ADHD co-morbid with pervasive developmental disorder required an individualized program for excessive time outs. The ADHD rating scale, symptoms of oppositional defiant disorder, and hyperactivity/inattention in Strength and Difficulties Questionnaires evaluated by parents significantly improved after STP. Although the 3-week STP was much shorter than most STPs run in the U.S., the program is more intensive than typical outpatient treatment, providing 105h of intervenion in 3 weeks. The short-term effect of the STP was demonstrated for Japanese children with ADHD. [Copyright &y& Elsevier]

This study examined responses to peer provocation in boys ages 9-13 years who met symptomatic criteria for ADHD-only, ODD/CD-only, comorbid ADHD/ODD/CD, or no diagnosis. Boys participated in a reaction-time game that included standardized verbal and behavioral provocation. Their behavioral, physiological, and affective responses to this task were measured. Results showed that groups did not differ following high levels of provocation because all boys behaved aggressively. However, following low provocation boys with comorbid ADHD/ODD/CD had higher levels of behavioral aggression, had greater heart rate acceleration, and were rated as angrier than all other boys. In addition, boys with comorbid ADHD/ODD/CD held a grudge longer than other children. Results suggest that boys with comorbid ADHD/ODD/CD are especially reactive to provocation from their peers. [ABSTRACT FROM AUTHOR]

Examines the expectancy effects of methylphenidate on the behavior and attributions of boys with attention-deficit/hyperactivity disorder. Attributions for success and failure on a daily report card; Beneficial effects of medications; Improvement of behavior.

As part of the behavioral treatment in the Multimodal Treatment Study of Children with ADHD (MTA9), children participated in an intensive summer treatment program (STP). This study examined the differences between 57 children in the combined treatment (Comb) group, who were medicated, and 60 children in the behavioral treatment (Beh) group, who were unmedicated throughout the STP. Comb children were significantly better than Beh on 5 measures: rule following, good sportsmanship, peer negative nominations, and STP teacher posttreatment ratings of inattention/overactivity. Groups did not differ on any of the other 30 measures, and responded similarly to the STP over time. Comparisons to normative data revealed that Comb children were more likely to fall within the normative range on 6 measures. The differences between these results and the main MTA results, in which Comb was always superior to Beh, are discussed in terms of the relative intensity of combined treatments. The implications for future studies of pharmacological and behavioral treatment for ADHD are discussed. [ABSTRACT FROM AUTHOR]

Levels of adult distress and ad lib alcohol consumption following interactions with child confederates were investigated in parents of children with no diagnosable psychiatric disorders. Sixty parents (20 married couples and 20 single mothers) interacted with boys trained to enact behaviors characteristic of either normal children or "deviant" children with externalizing behavior disorders--attention-deficit hyperactivity disorder (ADHD), conduct disorder (CD), and oppositional defiant disorder (ODD). Relative to the normal child role, interactions with deviant confederates were rated as significantly more unpleasant, resulted in feelings of role inadequacy, and produced significantly more anxiety, depression, and hostility. After the interactions, parents were given the opportunity to drink as much of their preferred alcoholic beverage as they desired while anticipating a second interaction with the same child. The participants consumed more alcohol following exposure to deviant as opposed to normal confederates. [ABSTRACT FROM AUTHOR]

The effects of methylphenidate on the academic performance and classroom behavior of 45 adolescents with attention deficit hyperactivity disorder were studied. During a 6-week, placebo-controlled medication assessment in the context of a summer treatment program, participants received a double-blind, crossover trial of 3 doses of methylphenidate. Dependent measures included note-taking quality, quiz and worksheet scores, written language usage and productivity, teacher ratings, on-task and disruptive behavior, and homework completion. Group data showed positive effects of methylphenidate on academic measures; however, the greatest benefit came with the lowest dose. Although additional benefit did occur for some participants with higher doses, the largest increment of change usually occurred between the placebo and 10-mg dose. Many adolescents did not experience added benefit with increased dosages, and in some cases they experienced deterioration. Guidelines for assessment of medication effects are discussed.

We investigated the effects of background anger, provocation, and methylphenidate on emotional, physiological, and behavioral responding in children with attention-deficit hyperactivity disorder (ADHD) with and without concurrent aggression. Our study revealed that ADHD boys showed more emotional and physiological distress when exposed to an interaction in which an administrator chastised each boy's favorite counselor, compared to a friendly interaction between the two adults. The background anger manipulation did not affect the aggressive behavior of the boys against an opponent in an aggressive game. High-aggressive (HA) ADHD boys were more likely to respond to provocation with aggression than low-aggressive (LA) ADHD boys, but only LA boys showed increased physiological reactivity with increasing provocation. Methylphenidate resulted in increased heart rates under all conditions and did not interact with any of the other findings.